The Truman Show Delusion: Real or Imagined?

A few delusional people are convinced they are stars of an imaginary reality show, but doctors disagree on whether it's only an act.

By Suzanne Wright

From the WebMD Archives

Two doctor/brothers, Joel and Ian Gold, have identified symptoms of a mental illness unique to our times: the Truman Show delusion, named for the 1998 movie that starred Jim Carrey as a suburbanite whose movements were filmed 24/7 and broadcast to the world. The two say a handful of individuals are convinced they are stars of an imaginary reality show.

Though limited, their findings are creating a buzz in the media and the psychiatric community: Is it possible that reality TV is shaping delusions?

In an interview with WebMD, Joel Gold says, “The Truman Show delusion encompasses a patient’s entire life. They believe their family, friends, and co-workers are all reading from scripts and their home, workplace, and hospital are all sets. They believe they are being filmed for the whole world to see.”

Joel Gold, who is on the psychiatric faculty of New York’s Bellevue Hospital and serves as a clinical assistant professional of psychiatry at New York University's School of Medicine, first began to see the symptoms dubbed Truman Show delusion in 2002 with patients at Bellevue Hospital. He initially treated five white male patients with middle-class upbringing and education, all who likened themselves to actors on reality TV shows. Three specifically referenced the movie TheTruman Show, giving rise to the disorder’s name.

“It’s important to state that Truman Show delusion is a symptom of psychosis,” Joel Gold says. “People who choose to be the center of attention, have concerns about social standing, or who may fear being in public eye or seek it out, may be more drawn to identify with this delusion. I don’t think people are making it up or choosing it.”

Both Golds are careful to say that the Truman Show delusion is not a new diagnosis, but rather, as Ian Gold says, “a variance on known persecutory and grandiose delusions.” Ian Gold, PhD, holds a Canada Research Chair in philosophy and psychiatry at McGill University in Montreal.

Although some psychologists scoff at the notion that cultural Zeitgeist can shape delusions, the phenomenon has precedence.

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Joseph Weiner, MD, PhD, chief of consultation psychiatry at North Shore University Hospital/Manhasset and associate professor of clinical psychiatry and medicine at Albert Einstein College of Medicine, weighed in via email about what he saw during his psychiatry residency.

“I recall two patients in one week who stated that they were Elizabeth Taylor; in the 1940s, psychotic patients would express delusions about their brains being controlled by radio waves; now delusional patients commonly complain about implanted computer chips,” Weiner says. “Because reality shows are so visible, it is an area that a patient can easily incorporate into a delusional system. Such a person would believe they are constantly being videotaped, watched, and commented upon by a large TV audience.”

Among the skeptics are Jill P. Weber, PhD, a licensed clinical psychologist in Vienna, Va. “The idea that more people are becoming delusional due to reality TV or The Truman Show phenomenon is tenuous, as it is likely that these people would have become psychotic with or without these influences, but the content of the delusion would be different. If we lived in a world of no TV, and entertainment was in the form of tribal dance, someone who is psychotic may begin to believe that the dance is only for them.”

Still, other experts acknowledge the possibility.

Simon Rego, PsyD, associate director of psychology training at New York’s Montefiore Medical Center, is intrigued by the notion but wants to see if more patients emerge in other cities and countries over time.

“We know that although core themes are quite stable, shifts take place,” he says. “For example, after 9/11, we saw a lot of delusional content about terrorists. With the exponential growth of reality TV and the use of personal web cams and Facebook, some people may be susceptible to developing Truman Show delusion. The danger is self-labeling -- that we are creating a phenomenon -- not discovering one. There’s a difference.”

Carole Lieberman, MD, a Beverly Hills-based media psychiatrist, says, “There is no question that reality TV is dangerous to our nation’s psyche. The Truman Show delusion has not been incorporated into the Diagnostic and Statistical Manual of the American Psychiatric Association, and it is unlikely that it will be anytime soon. However, this doesn’t necessarily negate the clinical experiences of the Drs. Gold.”

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Ian Gold says that although TheTruman Show film was played as for laughs, “there was an undercurrent of horror that was really powerful, that captures something of what this artificial environment would be like. Imagine if nobody was authentic [in your life], if every encounter you had was watched and you were utterly alone. The emails I have received since the story broke have brought home to me how terrifying this experience is.”

His brother concurs with the seriousness of the subject matter. Joel Gold has been bothered by some bloggers who have dismissed the Truman Show delusion as frivolous.

“This is a serious mental illness, it’s not silly or a form of narcissism. It’s a severe and persisting mental illness and we don’t want to make light of it. If you think the entire world is fraudulent, that is incredibly distressing.”

Is Pop Culture to Blame?

Does the pervasiveness of reality TV and cultural phenomena like YouTube predict more Truman Show delusion diagnoses in the future? Joel Gold thinks so.

“We’ve got the ‘perfect storm’ of reality TV and the Internet. These are powerful influences in the culture we live in and for some people who are predisposed, it might be overwhelming and trigger a [psychotic] episode. The pressure of living in a large, connected community can bring out the unstable side of more vulnerable people.”

Both doctors deny seeking “fame or glory” and say they are a bit overwhelmed by the media attention. They have been inundated with “wonderful and unexpected” emails and calls from clinicians, patients, and colleagues who are willing to share their stories. They now have worked on about 20 cases.

“The upside of publicity is the chance to study this properly and learn something about it,” Ian Gold says. His brother adds, “The Truman Show delusion asks more questions than it answers.”

The Golds are working on a medical paper that will provide a series of illustrative cases. “Given the recent feedback about our work, Truman Show delusion may be more widespread than we know,” Joel Gold says.

Ian Gold adds, “Reality TV doesn’t cause delusion, but is there something about reality TV that is particularly appropriate for expressing delusion once it has developed? We don’t know yet, but it’s fascinating to explore. There’s something about fame that people respond to. My hypothesis is that delusions have to do with our relationships with other people and the new media creates a larger community with more threats and opportunities.”